2026 Changes to Medicare

Published in 50Plus Magazine, October 1, 2025

Mara Woloshin

They say nothing is as constant as change, and Medicare is no exception. There are multiple changes coming to Advantage and prescription drug plans in 2026. Here are a few of the ways that these changes might affect your wallet in the coming year.

Rx Changes

Having a prescription denied by your plan is frustrating, but there is some good news. Beginning in 2026, the Centers for Medicare and Medicaid Services (CMS) is requiring plans to provide specific reasons for such denials, including the coverage rule used. This also applies to denials of procedures. Remember you can appeal these denials and should.

High medication prices are a challenge for many people, even those with insurance. Luckily, the Inflation Reduction Act reduced prescription drug costs in 2025. This legislation also placed a ceiling of $2,000 on out-of-pocket costs for all prescriptions. While the cap will rise to $2,100 in 2026, Medicare now has the right to negotiate DOWN high-price Part D drugs.

More good news: all adult vaccines are covered in 2026, including Shingles. Insulin will remain capped at $35 for a one-month supply. Additionally, the program known as Extra Help will be expanded to 150% of the federal poverty level. That makes more beneficiaries eligible, dramatically reducing costs at the pharmacy. Learn more or apply for Extra Help at www.ssa.gov or contact us.

As far as Medicare in 2026, there are both positive and negative changes that could impact your Medicare plan and your finances.

Plans

For changes specific to your own Medicare plan, look for the Annual Notice of Change (ANOC), which should have arrived in mailboxes by Sept 30. This mailing details your plan changes for the coming year. If you don’t receive this letter, call your plan for a copy. It is important to know what, if any, changes are coming in the new year so that you can make the right decision for yourself during annual enrollment about keeping or changing your plan.

Enrollment

While all health plans offer printed materials, virtually all now additionally offer digital copies. It can be much easier to change plans by enrolling online.

Read the article in 50Plus Magazine here https://50plusmagazine.net/2025/10/01/2026-changes-to-medicare/ and check out the rest of the 2026 Medicare Guide as well!

____________________________________________________________________________________

Mara Woloshin owns Woloshin Communications and is a Certified Retirement Coach, Medicare Consultant, and Health Educator. Learn more at woloshin.com.